SILO GOALS NURS 3021: Brendan Morano

September 23, 2022

Learning Needs

Previously through my school clinicals, I have done two online shadowhealth

placements (NURS 1020 for long term care and NURS 2021 for child & mental health

respectively) and one in person placement at Adam Scott Secondary School for NURS 2020’s

community placement. While I felt like the online did help build some of my skills, I believe that

it is hard to learn to be a nurse without the actual hands-on experience. I am lucky enough to

have gotten work opportunities as an extern, however this course will present challenges that I

have not yet encountered in my time in healthcare. From my understanding, I will have the

chance to take over my own patient load, administer medications, and perform skills such as

dressing changes and maybe, if I’m lucky, subcutaneous lines. For me, these are concrete skills I

want to build upon throughout this semester. However, another big goal of mine is to learn

how to talk to patients/families about the end and provide excellent care towards someone’s

final days.

Learning Goal #1

My biggest goal for this term is to learn how to appropriately and empathetically

communicate with patients who are nearing the end of their life and reduce my own anxiety I

have when talking about this topic. I believe that this is an appropriate goal as dying is a part of

life and a big part of healthcare, and it is important for all practitioners to have comfort when

caring for individuals who are in the process of dying, regardless of how imminent death may
be. Working on a palliative unit will provide ample opportunities to work on this skill and gain

increased comfort when discussing the subject going forward.

SMART GOAL #1

S: Gain comfort with discussing patients’ thoughts and feelings on death/dying

M: I will be able to routinely engage in conversation both during and after my clinical placement

(when appropriate) about my patient’s experiences and feelings on death

A: This is an attainable goal as the palliative unit will offer opportunities to talk with and get a

real-life experience when it comes to caring for an individual who is approaching the end of

their life.

R: This is a relevant goal as nurses must have excellent bedside manner and communication

skills. Regardless of the setting I will be working in there is a high chance I will have at least one

patient who is approaching the end of their lifespan

T: I hope to gain more confidence and accomplish this goal by the end of clinical placement

Goal #1: Activities and Timeframes

1. Take part in end-of-life care simulation.

2. Initiate conversation with patients throughout semester on thoughts/feelings of death.

3. Reflect on experience during clinical debriefs.

4. Keep track of anxiety/progress on midterm/final evaluation handbook.

Learning Goal #2
 Another goal I had set for myself was to continue to develop my skills when it comes to

dressing changes. I have experience with dressing changes, as I had to dress pressure sores on

my heel for close to two years. However, since beginning to work in healthcare, I’ve learned

that doing a dressing change on somebody else is a lot different than changing my own

bandages. Wound care is a key skill in nursing and being able to change a variety of

dressings/ostomies will serve me well in my clinical practice going forward. I have been lucky

enough to provide wound care for patients during my time as an extern, however it was mainly

on simple wounds that didn’t have any complex cleaning/packing requirements. Practicing this

skill under the supervision of my clinical instructor as well as nursing staff will greatly help my

skills going forward, especially if there are more complex wounds/dressings.

SMART GOAL #2

S: By the end of the semester, I will be able to complete a dressing change in a safe and timely

manner without asking questions or seeking approval.

M: I will be able to measure this goal as I will have nursing staff to support me and ask

questions if I need assistance

A: This is an attainable goal as this is a skill it is something I expect to be competent in by the

end of the semester

R: This is a relevant goal as I want to make the most out of my clinical experience, and any

chance I get to show off and improve my skills is a good one.

T: The timeframe is between now and the end of second semester.

Goal #2 Activities and Timeframes

1. Watch evolve Elsevier videos on dressing changes and participate in labs to practice

dressing changes

2. Perform dressing changes in clinical when provided opportunity to (September 29,

2022-end of semester)

3. Engage in constructive feedback from nursing staff and preceptor. Use this time to ask

questions and gain clarification (September 29, 2022-end of semester)

4. Perform dressing change in timely and safe manner (end of semester)

Learning Goal #3

My 3rd goal for the semester is to enhance my skills with medication administration. This

will be the first time that I am able to administer meds of any sorts in a practice setting. Have

competency with the ADU as well as the knowledge to provide good education on medications

will make me a better practitioner.

S: I will safely administer medications and operate the MAR with registered staff guidance

throughout the semester

M: I will measure how successful I am by seeking feedback from nursing staff as to ensure I did

the proper checks when going through medication administration.

A: This is an attainable goal as from what I understand we will be able to administer non-

controlled medications this semester

R: This is a relevant goal as nurses are expected to administer medications safely to all patients

regardless of the setting

T: This is a goal that will be ongoing as I continue my practice and gain more knowledge on

different medications and their uses

Goal #3: Activities and Timeframes

1. Practice medication administration in labs/simulations (September 1, 2022-September

23, 2022)

2. Bring drug book to clinical for my own reference if needed

3. Review rights of medication administration on Elsevier (Before labs and clinical, review

as needed throughout semester).

4. Administer medications under eyes of preceptor/nursing staff (whenever the

opportunity arises this semester)

How to my learning goals support my commitment to continuing competency

My learning goals support my commitment to continuing competency as I needed to

reflect on my past experiences working in healthcare and chose what I felt are the most

important skills I can gain from this clinical placement. I have worked in emerge, acute

medicine, and CCC, all of which require me to learn the skills I have mentioned in this

document. As a student nurse, this shows my commitment to continuing competency because I

am trying to build on the knowledge I already have and the skills I need to continue to develop

before I am licenced so I am a safer, more confident, and more skilled when I have a full scope

of practice.
Evaluation of Changes/Outcomes to my practice

Throughout the semester, I will be keeping track of our clinical days for my midterm and

final evaluations. I feel that generally, I will be a more confident practitioner and have a greater

skillset than before. At the end of the semester, I will have reduced anxiety over the aspect of

death within my practice. I feel that this will make me a better healthcare practitioner because

(as stated previously) death is inevitability in healthcare and on life. Part of what I have enjoyed

about my work as an extern the most is the connections; I’ve been able to make with other

people and the wisdom that some of my patients have been kind enough to impart on me. I feel

that hearing stories from people of all different walks of life is a quite rewarding and help puts

my own life in perspective. Being able to care for someone in their final days will certainly be an

enriching experience.

When it comes to my dressing changes, the ideal outcome would be for me to have

enhanced knowledge of various wound care products/coverings/styles of dressings. I feel

confident about my knowledge and application of some dressing materials (inadine, bactigras,

mepilex etc.) but I am aware that there are several products I have not yet encountered in my

practice. By the end of the semester, I feel that I should be largely independent when it comes

to changing dressings.

Finally, I will be able to operate the MAR and administer medication safely and

effectively. Part of having my own patient responsibility will be administering medications while

practicing the rights of proper medication administration. Building my medication skills in this

setting is key as once I am licenced, I will be able to give patients drugs that are much more
potent, such as narcotics and benzodiazepines. Getting opportunities -even if the medications

aren’t “controlled substances”- to administer meds in a healthcare setting is a valuable learning

experience that I hope to take full advantage of.